Concerns have been raised about the safety and effectiveness of opioid analgesics for chronic non-cancer pain in view of a threefold increase in opioid prescribing and a dramatic increase in the rates of opioid-related adverse outcomes. Our preliminary data showed the rate of opioid prescriptions for older adults varied dramatically across states, from 2.7% in Texas to 14.5% in Alaska for schedule II and from 11.7% in New Jersey to 34.8% in Alabama for schedule III. We also found exceedingly high variability in prescribing schedule II/III opioids among primary care physicians (PCPs); the percentage of PCPs prescribing opioids to their non-cancer patients ranged from 0.4% to 70.5%. Twenty-three percent of the variance in whether an elderly patient received an opioid was explained by which PCP the patient saw. Such high variation in opioid prescribing-even after adjustment for patient mix-offers critical insight into the complexity and confusion surrounding this issue. On any given day, providers-faced with difficult decisions about treating patients with severe pain-must carefully balance the risks of overtreatment versus undertreatment. To date, no nationally representative studies have examined variations in the use of opioids in older adults and their relationship to outcomes, different state regulations, and federal policy. Our Specific Aims are: 1. Examine temporal changes in the prevalence, duration, and dose of opioid use in older adults, with particular focus on the impact of policy changes. 2. Assess the variation of opioid use across providers and determine patient and provider factors associated with opioid use in older adults. 3. Examine the risk of adverse outcomes-including falls, fractures, emergency room (ER) visits, hospitalization, institutionalization, and mortality-in older patients receiving opioids. We will use 2007-2015 100% national data on Medicare beneficiaries to investigate this escalating public health crisis. The proposed investigation will provide data that can lead to improvements in public policy and clinical practice guidelines for ensuring safe and effective use of opioids in older adults.